Friday, 15 September 2017

Brain Health Put to the Test

Have your heard of Brain Health

If not why no go...their now!


The principle ideas is to treat to the target of no evident disease activity and you can get the big guns out at the start of the disease or you can try the escalation approach starting with the CRABs and working your way up the potential side-effect scale with more highly effective agents. 

Grants have been scare but like buses, two come along at the same time.

"When deciding on a disease-modifying treatment (DMT), persons with relapsing-remitting multiple sclerosis (PwRRMS) and neurologists are currently faced with the dilemma of adopting one of two treatment approaches: an escalation approach, starting a drug that is considered safe but with a modest likelihood to control the MS activity (attacks and new lesions), and escalating to more potent therapies in the face of continued disease activity; or an early highly effective treatment (EHT) approach, which, in contrast, involves giving a high-efficacy drug, with the rare potential for significant adverse effects, as the first-line treatment. The study population will be PwRRMS who have never been on a DMT recruited from MS treatment centers in the United States and the United Kingdom".

The trial has now been funded by PCORI  for $10,630

They obviously liked the idea so much that they have funded essentially the same trial again and the proposed study will evaluate "if the slowly worsening phase of MS can be prevented or delayed by using stronger MS treatments up front. We will perform a randomized clinical trial of 900 people with MS"...costing $13,460,000.

So the PCORI mega MS budget has now probably been spent, with another $11,000 on studies on fatigue management and exercise intervention

Some say it is a hard decision to know which treatment to take. These DMT studies hopefully will show the way forward. This study idea was put up for funding within the UK (at a fraction of the cost) a few years ago and it got knocked back. 

So the MS Society's question from the James Lind Alliance gets answered does early highly effective treatment give benefit...the answer will come in 2023.

But on the issue of decisions on treatment. A whole set of marketing shows how complex the treatments but

If you accept, which many haven't read:-(, our suggestion that they all work the same way....by depleting memory B cells, then selection of which agents to chose then the selection becomes easier.

If you are interested in efficacy you ask which ones reduce the memory B cells the best and then you can factor in safety and convenience.

CoI. None relevant

10 comments:

  1. "If you accept, which many haven't read:-(, our suggestion that they all work the same way....by depleting memory B cells, then selection of which agents to chose then the selection becomes easier."

    How does it become easier..? Is there a chart that shows
    Copaxone depletes 30%..Betaseron 50%..and ocrevus 99%
    There is no such chart on this site..and why is there not one ?

    ReplyDelete
  2. You could read papers like Dooley et al.
    https://www.ncbi.nlm.nih.gov/pubmed/27231713 or Baker et al
    https://www.ncbi.nlm.nih.gov/pubmed/28161400

    They you can see the weaker DMT have a large spread of activity and the higher efficacy have a smaller spread, but the question unknown is what is the cut-off. We are waiting to see the data from Genzyme to see if it can help us make this call but we have been waiting for 10 months already.

    So we are aiming to do this, but we don't have a lot of people on CRAB drugs, we are hoping for MS Society support to do this. We have had the thumbs up.

    ReplyDelete
    Replies
    1. P.S. Pharma won't like this idea because if you are in the low end of activity it is a negative, however their levels of efficacy are known.

      We will now see a slew of activity trying to disprove this, bring it on this is what popperian science is about.

      Delete
    2. Here's the problem in a nutshell..the graphics are like ancient hieroglyphics from lost alien tribe out of the Rings of Saturn. No wonder:"When it comes to prescription rates, the UK ranks 25th out of 27 European countries. Given the relative wealth of the UK this is simply unacceptable."
      http://www.bbc.com/news/health-22307916

      http://www.ebiomedicine.com/cms/attachment/2085207965/2073764223/gr4.jpg

      Delete
  3. I ike the sound of this Dr G but my main reason for commenting is to ask your reaction to my Smartphone/Cog-fog metrication idea.
    Incidentally my daughter Dr Jo Stratton is arriving for a visit on Tuesday. My wish is for you and her to meet. I sense kindredness of spirit

    ReplyDelete
  4. Some of those high efficacy drugs have more than a rare chance of side effects. People on Lemtrada have a 40% likelihood of developing a secondary autoimmune disease. Of course one has to make the decision with their doctor on what is best for them

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  5. lol stay tuned for 2023... what happens if in 2023 the study concludes that further studies are needed? :D

    ReplyDelete
    Replies
    1. The results will read out as the trials are finished

      Delete
    2. come on, what was the last time a study was done on anything that didn't conclude that more studies are needed to conclusively determine an issue?

      Delete

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